Vaginal cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

Overview

Vaginal cancer must be differentiated from cervical carcinoma, rectal carcinoma, uterine carcinoma, vaginal lymphoma, vaginal cyst, vaginal node of endometriosis, and uterine fibroids.

Differential diagnosis

For large lesions consider invasion of the vagina by:

Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.

Other differential considerations include:


Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Abnormal vaginal dyscharge Pelvic

pain

Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal

mass

HPV Pap smear STI Panel Ultrasound MRI CT Scan
Vaginal cancer[1][2][3][4]

+

+ +/- +/- + − − − Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
 Biopsy findings:
Cervical cancer[5][6][7][8][9][10][11][12] + + + +

+

+ ± ±Chlamydia T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
 PET/CT scan:
Cervical polyp[13][14][15] + − − − − − − − − − May reveal presence of tumor CT contrast may show presence of a well defined mass
Cervical leiomyoma[16][17][18][19][20][21][22][23] + + − − + ±
− − −
  • Well circumscribed hyperechoic mass
 T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
 N/A
Cervical lymphoma[24][25][26] − + − + +
  • Irregularity
 + − − −
  • Well-defined, solid, concentric, hypoechoic mass
 MRI: Diffuse heterogeneous uterine/cervical mass & hypoechoic enlarged iliac lymph nodes
Cervical sarcoma[27][28][29][30] ± + − ± + + − − − MRI: N/A
Cervical erosion(Ectropion)[31][32][33][34][35] + + ± − + − − − − - N/A N/A N/A
Cervicitis[36][37][38][39] + + +/- − − − To detect complications like PID N/A N/A N/A
IUD use[40][41][42] ± + − +/- − − − ± To detect IUD location and pregnancy N/A N/A N/A Physical exam and ultrasound
Pelvic inflammatory diseases[43][44] + +
  • Fever
 ±Abdominal

pain

− − − Thickened fluid filled fallopian tubes N/A May show endometritis
Endometriosis[45][46][47][48][49][50] ± − − + + − − −
  • Unilocular/multilocular cysts contating thin/thick septations
  • Increased vascularity showing increased doppler flow
  • Hyperintensity on T1 weighted images
  • Hypointensity on T2 weighted images
 Presence of endometrial tissue outside the uterus
Adenomyosis[51][52][53][54][55] − + − − +/- +/- − − − MRI:
  • Thickened junctional zone
Cervical ectopic pregnancy[56][57] − − − − + − − T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
 N/A
DES exposure (Clear cell adenocarcinoma)[58][59][60] + +/- +/- +/- + - − − − To determine uterine extent To detect metastases
Paget's disease of vulva to cervix[61][62][63] ± − − −
− − − − − N/A MRI:
  • Hyperintense on diffusion weighted images
Nabothian cyst[64][65][66][67] + − − − - − − − −
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images
  • Small cysts not visible on CT
  • Large cysts seen as focal low attenuation region
Rectal cancer[68][69][70][71][72] - - + - Weight loss + LLQ + NL + - - +/- Endoscopic/transrectal US detects tumor extent Determine tumor stage Determine tumor stage Colonoscopy with biopsy
Submucous uterine leiomyoma[73][74][75] Menorrhagia - + - - + Enlarged, irregular, firm, nontender uterus + - - - Provides information on no: of fibroids, size, vascularization, relationship with endometrial cavity & serosal surface Not required Not required Physical examination with Ultrasound
Uterine cancer[76][77][78][79] + + - + + - - - Thickened endometrial lining >4cm Not required Histologic diagnosis
Vaginal lymphoma[80][81][82] + + + + Abdominal/pelvic pain - + Palpable mass between rectum & vagina +/- - - - Diffuse mass in external cervical orifice & invading the vagina Diffuse mass in external cervical orifice & invading the vagina Not required CD20 & CD79a positive Immunohistochemistry & biopsy
Vaginal polyp[83][84][85][86] Postmenopausal bleeding + + + - + Mass protruding from vagina +/- - - - To exclude uterine hyperplasia/carcinoma To determine the extent N/A Benign tissue/premalignant cells Excisional biopsy
Vaginal adenosis[87][88] +/- +/- +/- - - - Palpable cysts,nodularity or ulcers - - - - N/A N/A N/A Columnar cells in the ectocervix Biopsy with histopathological examination

References

  1. ↑ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
  2. ↑ Miccò, Maura; Sala, Evis; Lakhman, Yulia; Hricak, Hedvig; Vargas, Hebert Alberto (2015). "Imaging Features of Uncommon Gynecologic Cancers". American Journal of Roentgenology. 205 (6): 1346–1359. doi:10.2214/AJR.14.12695. ISSN 0361-803X.
  3. ↑ Kim, Hwi-Gon; Song, Yong Jung; Na, Yong Jin; Choi, Ook-Hwan (2013). "A Case of Vaginal Cancer with Uterine Prolapse". Journal of Menopausal Medicine. 19 (3): 139. doi:10.6118/jmm.2013.19.3.139. ISSN 2288-6478.
  4. ↑ Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C (2006). "Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report". Eur. J. Gynaecol. Oncol. 27 (5): 528–30. PMID 17139994.
  5. ↑ Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
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  7. ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
  8. ↑ . doi:10.1097/PAS.0000000000000498. Check |doi= value (help). Missing or empty |title= (help)
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  11. ↑ Qing L, Xiang T, Guofu Z, Weiwei F (September 2014). "Leukemoid reaction in cervical cancer: a case report and review of the literature". BMC Cancer. 14: 670. doi:10.1186/1471-2407-14-670. PMC 4174654. PMID 25223869.
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  65. ↑ Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.
  66. ↑ Torky, Haitham A. (2016). "Huge Nabothian cyst causing Hematometra (case report)". European Journal of Obstetrics & Gynecology and Reproductive Biology. 207: 238–240. doi:10.1016/j.ejogrb.2016.10.042. ISSN 0301-2115.
  67. ↑ Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.
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  72. ↑ Mohammad Sadegh Fazeli & Mohammad Reza Keramati (2015). "Rectal cancer: a review". Medical journal of the Islamic Republic of Iran. 29: 171. PMID 26034724.
  73. ↑ Jacques Donnez & Marie-Madeleine Dolmans (2016). "Uterine fibroid management: from the present to the future". Human reproduction update. 22 (6): 665–686. doi:10.1093/humupd/dmw023. PMID 27466209. Unknown parameter |month= ignored (help)
  74. ↑ Mohamed Sabry & Ayman Al-Hendy (2012). "Medical treatment of uterine leiomyoma". Reproductive sciences (Thousand Oaks, Calif.). 19 (4): 339–353. doi:10.1177/1933719111432867. PMID 22378865. Unknown parameter |month= ignored (help)
  75. ↑ Sahana Gupta, Jude Jose & Isaac Manyonda (2008). "Clinical presentation of fibroids". Best practice & research. Clinical obstetrics & gynaecology. 22 (4): 615–626. doi:10.1016/j.bpobgyn.2008.01.008. PMID 18372219. Unknown parameter |month= ignored (help)
  76. ↑ "ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer". Obstet Gynecol. 106 (2): 413–25. August 2005. PMID 16055605.
  77. ↑ Boruta DM, Gehrig PA, Fader AN, Olawaiye AB (October 2009). "Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review". Gynecol. Oncol. 115 (1): 142–153. doi:10.1016/j.ygyno.2009.06.011. PMID 19592079.
  78. ↑ Bokhman JV (February 1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.
  79. ↑ Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F (November 2010). "Factors associated with Type I and Type II endometrial cancer". Cancer Causes Control. 21 (11): 1851–6. doi:10.1007/s10552-010-9612-8. PMC 2962676. PMID 20628804.
  80. ↑ Vera Silva, Paulo Correia, Nuno Oliveira & Luis Sa (2015). "Primary Vaginal Non-Hodgkin's Lymphoma: Report of a Rare Clinical Entity". Clinics and practice. 5 (4): 821. doi:10.4081/cp.2015.821. PMID 26918105. Unknown parameter |month= ignored (help)
  81. ↑ Feng Wang, Xuquan Jing, Bo Liu, Xue Meng, Xindong Sun, Yongsheng Gao, Linlin Wang & Zheng Fu (2018). "Primary non-Hodgkin's lymphoma of the vagina: A case report". Oncology letters. 15 (3): 3504–3507. doi:10.3892/ol.2018.7805. PMID 29556272. Unknown parameter |month= ignored (help)
  82. ↑ Salvatore Guastafierro, Amando Tedeschi, Clelia Criscuolo, Maria Celentano, Luigi Cobellis, Raffaele Rossiello & Umberto Falcone (2012). "Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature". Acta haematologica. 128 (1): 33–38. doi:10.1159/000337336. PMID 22584110.
  83. ↑ A. I. al-Nafussi, G. Rebello, D. Hughes & K. Blessing (1992). "Benign vaginal polyp: a histological, histochemical and immunohistochemical study of 20 polyps with comparison to normal vaginal subepithelial layer". Histopathology. 20 (2): 145–150. PMID 1302457. Unknown parameter |month= ignored (help)
  84. ↑ Sunil Kumar Samal, Setu Rathod & Seetesh Ghose (2015). "Fibroepithelial Polyps of the Vagina in Pregnancy". Journal of clinical and diagnostic research : JCDR. 9 (10): QJ01–QJ02. doi:10.7860/JCDR/2015/13329.6656. PMID 26557576. Unknown parameter |month= ignored (help)
  85. ↑ M. Petrova, J. Laco, K. Cervicek & M. Tomsova (2015). "[Tubulo-squamous polyp of the vagina]". Ceska gynekologie. 80 (3): 173–175. PMID 26087210. Unknown parameter |month= ignored (help)
  86. ↑ Alexis Heller, Adanna Ukazu & Qing Wang (2017). "Pseudosarcomatous Vaginal Polyp". International journal of surgical pathology. 25 (1): 54–55. doi:10.1177/1066896916666676. Unknown parameter |month= ignored (help)
  87. ↑ Marguerite B. Vigliani (2017). "A Report of Two Cases of Age-Related Changes in Cervical Morphology in Postmenopausal Women with Vaginal Adenosis". Case reports in obstetrics and gynecology. 2017: 9523853. doi:10.1155/2017/9523853. PMID 28316850.
  88. ↑ Tiantian Han, Ying Jin, Yan Li, Yalan Bi & Lingya Pan (2018). "Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden: A retrospective study". Medicine. 97 (49): e13470. doi:10.1097/MD.0000000000013470. PMID 30544435. Unknown parameter |month= ignored (help)
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